Rosh Emergency Medicine Practice Test

What are the most likely exam findings based on the diagnosis in a patient with weight gain and fatigue?

1. Coarse skin and bradycardia

2. Hyperactive deep tendon reflexes

3. Lid lag and onycholysis

4. Pretibial myxedema and ophthalmopathy

The correct answer is: Coarse skin and bradycardia

The presence of coarse skin and bradycardia is indicative of hypothyroidism, a condition characterized by an underactive thyroid gland. Patients with hypothyroidism often experience features such as weight gain, fatigue, cold intolerance, dry skin, and alterations in heart rate, leading to bradycardia. Coarse skin can develop due to a decrease in the metabolic rate and impaired skin turnover. In contrast, hyperactive deep tendon reflexes, lid lag and onycholysis, as well as pretibial myxedema and ophthalmopathy are findings typically associated with hyperthyroidism and other specific thyroid and autoimmune conditions. Hyperthyroidism would manifest with increased metabolic activity, resulting in symptoms like weight loss, increased heart rate, and other features divergent from those of hypothyroidism. Thus, the findings of coarse skin and bradycardia align closely with the symptomatology of hypothyroidism, making this the most likely diagnosis based on the described symptoms.